Telenurses provide effective advice

Telenurses can provide effective advice to people who would otherwise visit an emergency department

Seven out of eight people who sought advice from a telephone helpline staffed by nurses followed the self-care advice they received, ranging from providing treatment at home to calling an ambulance, according to a study in the April issue of the Journal of Clinical Nursing.

Two factors had a significant impact on the decision to engage in self-care for themselves or the person they were calling for. Callers who were more satisfied with the nurse interaction were nearly four times more likely to engage in self-care than those who were less satisfied and 11% more likely to engage in self-care if the nurse made them feel confident to do so.

Callers were also much more likely to engage in self-care if the nurse stressed the importance of following the professional advice they were being given and they agreed with the advice that had been provided.

The authors believe that the Canadian research, led by the University of Alberta, confirms that nurse triage helplines can be a cost-effective method of addressing the self-care needs of individuals who would otherwise visit an emergency department.

Researchers spoke to 312 people who called the LINK telephone health advice line, which was established in Alberta in 2000.

"LINK is a telephone triage service provided by qualified nurses 24 hours a day, seven days a week" explains lead author Dr Bev Williams, Associate Professor in the Faculty of Nursing at the University.

"Nurses use computer-assisted guidelines and their own nursing experience to assess a caller's health concerns before suggesting the most appropriate type of care. Their advice is in accordance with evidence-based treatment protocols that are regularly reviewed in line with the latest medical and nursing literature.

"At the end of the call, the nurse recommends that the patient either engages in self-care at home, pays a routine visit to their practitioner, visits an emergency department immediately or calls an ambulance."

People who had called the service and been given advice over a one-year period were chosen using a random number generator, with the final sample reflecting the general pattern of calls during different times of the day. The researchers made contact with the callers and 312 agreed to take part in 20-minute interviews.

Key findings of the study included:

• Women made up 92% of the final sample and 85% of callers were under 40 years old, with the largest percentage (53%) between the ages of 18 and 29. Only 7% were in their 40s, 5% were in their 50s and 3% were 60 or over.

• Two-thirds had attended college or university (39% achieving qualifications) and only 11% had not achieved their high school diploma. The majority lived in urban areas (85%).

• The most common calls were about colds and flu (18%), pregnancy/post pregnancy and diarrhoea/vomiting (both 9%) and infections/diseases (8%).

• Nearly two-thirds of callers (62%) were calling for someone else and in 94% of cases this was a child.
• Those who engaged in self-care had called the service an average of 11.5 times before and the figure for those who did not follow the advice was slightly higher at 13.5.

• Just over a third of callers (38%) had considered other sources of information before calling and the top three were family and friends (26%), the internet (22%) and their doctor (12%).

• Seven out of eight callers (87.5%) said they engaged in self-care of some description as a result of the call.

• The majority (99%) said that the clarity of the nurse's advice was an important or very important factor in their decision to engage in self-care. Other key factors were: how comfortable the nurse was to talk to (93%), how confident they were in the nurse's advice (92%) and how easy the nurse's advice was to follow (89%).

• The findings were similar for those who did or did not engage in self-care, with two notable exceptions. Callers who engaged in self-care were much more likely to rate how strongly the nurse emphasised the importance of following the advice (85% versus 67%) and how much they agreed with what the nurse advised them to do (82% versus 74%).

"These findings underline the importance of the caller having a positive experience and feeling reassured about their ability to provide care for themselves or the person they are calling for" concludes Dr Williams.

"We are now carrying out further research to find out whether people who presented to emergency departments with minor illnesses were aware of the LINK service or had tried self-care before their visit."